Surveyors and Sundowners

Specialties Geriatric

Published

State surveyors are doing there annual survey, and all the while they were there today. things went ok. I didn't have anyone follow me on my med today, they focused mainly on resident interviews and dietary issues. Admin and all the big wigs were in. I had help on my hall that I had never had before. But I'm sure my hall got tagged for a couple things. One I feel is due to short staffing and another due to just the chaos of having everyone from everywhere trying to help and just getting in the way. People from the laundry and housekeeping were on the halls anwering lights and passing trays. I know my hall got tagged for a safety/fire hazard. as are hall was getting cluttered with wheelchairs, lifts, carts and things that I had never seen before...I asked my CNA about a lift that we don't even use on our hall, she said she didn't know who put it there. we figure it had to do with all the 'help" we were getting from other depts. So that was tag #1. Then at 6pm after all our "help" had gone, I had a med due for a res. who is in a vegetative state and who has a peg tube. (it was rumored that surveyors where watching all peg tube and bed bound res.) so I told my CNA that was on the floor (as the other CNA was in the dinning room assisting with meal time) that it was 6pm and res was on an even hr turn schedule, so my CNA and I turned this res and I gave the meds. When we came out of the room, one of the office staff told us that we had a light on and the surveyor was on the hall and had answered it. There were no lights on when we went in the room. And it was me and my one CNA on the hall at that time. So I'm pretty sure that was Tag # 2. What can you do ?? Surveyors leave and then.....ALL H--L BREAKS LOOSE. It was like the res all got together and said "LETS GO CRAZY" Atleast all the sundowner ones anyway. I went to lunch and 15 min later the other nurse comes to tell me that one of my residents called the cops on me. He called 911 cause he couldn't find his nurse. then another resident decided she wanted to fight with everyone. Literally, and she's very sneaky about it. She is in a w/c but she will go up behind someone and push them. "to get them out of the way" well she did that to 2 other confused residents. The one res. cried the other fought back. Then another resident had hidden contraband in her dresser. And I was trying to send another one out to the hosp. Now all this happened SIMULTANEOUSLY within the hour after the surveyors left. I WAS 2 HOURS LATE STARTING MY 8 00 MED PASS !!! I finally got to leave at 2am. And I'm so wired because I'm so tired, that when I got home tonight I decided tonight was a 5 glasses of wine kinda night. So I'm on my 5th glass of wine and I'm ready for bed. I had to laugh about it because there was just nothing else to do but laugh. It just seemed like Murphy's law trumped the whole day !!

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Why would someone get tagged for not answering a call light when they were occupied? In our rooms you can't hear call lights, only in the hallway. If you didn't answer it after you saw it, I get the tag, but if you didn't hear/see it I'm sure you can't get a tag for that.

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Specializes in Gerontology, Med surg, Home Health.

I've never heard of someo e getting tagged for not answering one call light. But then again I've never seen a surveyor answer a light.

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I don't know I'm beginning to wonder is Admin is just saying that to scare us. The DON was telling my CNA's that the surveyors were targeting my hall. Got my CNA's all worked up and in a panic. I told them the surveyors are on every hall. Not just ours. The surveyor asked me how I determine the assignments for my cna's based on the quality of care. I told her I prioritize based on the acuity of care. She acutally said to me "good girl" and when I looked at her and said "what?" she said most people will say "acuity? what's that?" Apperently I had the right answer and when she asked me how do I ensure that my cna's are doing peri-care. I told her that i don't go behind them and check them, I do it with them. I will help them turn and position and change residents if they need it, and I know it's getting done because I am doing it with them, and that it all boils down to the realtionship you have with your aids and if you have a great working relationship with them then you will have great teamwork, when she asked how i prevent burnout with my cna's i told her if I notice that one of my aids is getting flustered I wil have the other CNA step in so the other one can step out and take a break if she needs to. She said that was all very good. So i am hoping that she maybe had given me some kudos with the DON and Admin.

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Specializes in LTC,Hospice/palliative care,acute care.
I don't know I'm beginning to wonder is Admin is just saying that to scare us. The DON was telling my CNA's that the surveyors were targeting my hall. Got my CNA's all worked up and in a panic. I told them the surveyors are on every hall. Not just ours. The surveyor asked me how I determine the assignments for my cna's based on the quality of care. I told her I prioritize based on the acuity of care. She acutally said to me "good girl" and when I looked at her and said "what?" she said most people will say "acuity? what's that?" Apperently I had the right answer and when she asked me how do I ensure that my cna's are doing peri-care. I told her that i don't go behind them and check them, I do it with them. I will help them turn and position and change residents if they need it, and I know it's getting done because I am doing it with them, and that it all boils down to the realtionship you have with your aids and if you have a great working relationship with them then you will have great teamwork, when she asked how i prevent burnout with my cna's i told her if I notice that one of my aids is getting flustered I wil have the other CNA step in so the other one can step out and take a break if she needs to. She said that was all very good. So i am hoping that she maybe had given me some kudos with the DON and Admin.

"Good Girl" !!! what are you, a frigging beagle? I'm afraid I would NOT have responded to that comment in a calm manner. That is so dis-respectful and condescending (IMHO) Assignments according to acuity is a joke on our dementia unit-we have to juggle the staff around according to the response they get from each particular resident and that can change several times a day. Sheesh-you know your staff is doing proper peri care by lots of factors including #1 your UTI -infection rate #2 skin intergrity and #3 by following your nose for goodness' sake. If I do peri-care with the cna's when the heck am I getting finger sticks and giving coverage and assessing my resident's with acute changes? When am I getting my med pass completed ? I just can't wait for our survey.

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"Good Girl" !!! what are you, a frigging beagle? I'm afraid I would NOT have responded to that comment in a calm manner. That is so dis-respectful and condescending (IMHO) Assignments according to acuity is a joke on our dementia unit-we have to juggle the staff around according to the response they get from each particular resident and that can change several times a day. Sheesh-you know your staff is doing proper peri care by lots of factors including #1 your UTI -infection rate #2 skin intergrity and #3 by following your nose for goodness' sake. If I do peri-care with the cna's when the heck am I getting finger sticks and giving coverage and assessing my resident's with acute changes? When am I getting my med pass completed ? I just can't wait for our survey.

"Good Girl" !!! what are you, a frigging beagle? I'm afraid I would NOT have responded to that comment in a calm manner. That is so dis-respectful and condescending

I didn't see it as condescending, considering that it was an older lady and she was not at all intimidating. She actually seemed surprised by my answer.

Assignments according to acuity is a joke on our dementia unit-we have to juggle the staff around according to the response they get from each particular resident and that can change several times a day.

it all comes down to the individual resident and how much care they need. and yes that can and does change frequently, but if ms X needs changed b/c she is wet/dirty and mr Y needs changed because he is wet, but ms X is totally dependent and has a continuous tube feed and can not turn herself and is a 2 person assist, mr Y is a 1 person assist and wanders around in his w/c. Who do you change first ??

If I do peri-care with the cna's when the heck am I getting finger sticks and giving coverage and assessing my resident's with acute changes? When am I getting my med pass completed ? I just can't wait for our survey.

obviously you can't help do pericare on every round with your cna's but when you have treatments that need to be done or barrier cream that needs to be applied or even a skin assessment, when is the best time to do that ?? When your aids are doing there rounds and turning people. And my Med Pass is atleast 2 1/2 hrs long and in that time that I'm passing meds and I see an opprotunity do a quick skin assesment and also give res there meds, is usually during the time the cna's are doing a round. And when it comes to assessing res. with acute changes, they are your focus. I'm not saying I do peri care with them on every res. What I'm saying is if they are doing there rounds then I have the opprotunity to do an acurate skin assessment and apply treatments and there are alot of times I will tell my aids to come and get me when they change ms. Y so i can assess for skin breakdown and apply treatment to her peri area.

you almost make is sound as if all I am doing is helping the cna's with there rounds. I assure I am not. I do my med pass and I assess my res. and if they have any change in condition I do what is necessary to take care of it. Most of the time it is my CNA's that find these change in conditions. I also chart on all my skilled residents, and my other res. who are not skilled that I have to chart on if they have had a change in condition. I can do an assessment at the same time as passing my meds and also help the CNA's. I guess if I didn't help the CNA's and at the same time do my assessments. I might get out on time. But as it goes, I never get out on time, I am always staying over my shift by atleast 2 hrs, and I know I am not the only one. Plenty of the nurses on all shifts stay over to finish charting.

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You state, " I'm usually staying over at least 2 hours to finish charting". I'm surprised your DON has not approached you, inquiring why so much overtime.

I know that in the facility I work in, if I stayed over 2 hours everyday there would be some red flag waving and I'd be explaining this to the DON.

I'm also going to say, it's possible to probably cut back on all this "staying over" if you can develop delegating skills, that way the CNAs can be doing more of their work, instead of you doing it for them, that would leave you the time to complete your own assignment.

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Specializes in LTC,Hospice/palliative care,acute care.

I'm surprised your overtime has been allowed to continue. They've come down HARD where I work. IMHO the fastest way to burn out is trying to do it all-,trying to please everyone from the admin through the resident's, their family's and the cna's and never taking a break or leaving on time. That's a recipe for disaster. You have to take care of yourself ...

You seem to be comparing assignments based on acuity to prioritizing the resident's needs through the day. On my units the more experienced cna's don't need help with that (the scenario you wrote) My inexperienced ones certainly need more guidance and I've seen more then one freak out when 2 residents need something at the same time. That's when I will jump in and toilet a resident that can transfer with min assist or transport someone off the unit to an appointment IF I have time. And I make sure to explain to the cna why she should prioritize one task over the other.Gotta get those meds out on time-we have 1 hour before and 1 hour after the scheduled times-we start at 8 am and 12 noon.I also want to assess the folks with acute changes and get a progress note written on each by 10 ish.

To be honest I'm more then a little burned out right now-ridiculous family members and clueless new admin making senseless changes has me updating my resume...You GIVE and GIVE and GIVE and somehow it's NEVER freaking enough.....But that's another thread and I have to keep my own counsel right now-don't want to post any identifying info....

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You state, " I'm usually staying over at least 2 hours to finish charting". I'm surprised your DON has not approached you, inquiring why so much overtime.

I know that in the facility I work in, if I stayed over 2 hours everyday there would be some red flag waving and I'd be explaining this to the DON.

I'm also going to say, it's possible to probably cut back on all this "staying over" if you can develop delegating skills, that way the CNAs can be doing more of their work, instead of you doing it for them, that would leave you the time to complete your own assignment.

There is an office nurse who will pick up a couple extra shifts if we are short, and she has been telling the admin and DON that if they really want to cut down on the OT, then they need to get us another nurse like they used to have a couple yrs ago. Most everyone stays over atleast 2 hrs to get the charting done. On all shifts, it's not got anything to do with prioritizing or delegating, we all have 25 - 30 residents that we are taking care of and our med passes take anywhere from 2 - 3 hrs, not to mention all the interruptions, admits, if someone falls or has a change in condition we have to stop our med pass and take care of all that and calls the dr's and family's. Our facility is not small we have 150 beds with 35 of those beds being our rehab unit and right now we have about 10 empty beds. So another nurse would be wonderful and would really cut back on the OT.

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